POS1360 TRANSIENT ELASTOGRAPHY (FIBROSCAN); AS A NEW NON-INVASIVE DIAGNOSTIC METHOD FOR DETECTING HEPATIC INVOLVEMENT OF AMYLOIDOSIS
Authors: M. Bektaş, B. Çavuş, B. F. Agargun, V. Şenkal, N. Koca, B. Ince, P. Özer Karaca, M. Mestanzade, M. Büyük, M. Z. Buğra, M. Güllüoğlu, S. Kalayoğlu Beşişik, Y. Yalçinkaya, B. Artim-Esen, M. Inanc, S. F. Beşişik, A. Gül
Journal: Annals of the Rheumatic Diseases (2022)

Background Demonstration of deposits by non-invasive methods is important especially for organs difficult to sample in amyloidosis. Transient elastography (fibroscan) is a diagnostic method being used to measure liver stiffness (LS) in different chronic liver diseases. Objectives We herein aimed to test the place of fibroscan method for detecting increased LS associated with amyloid deposition in patients (pts) with amyloidosis. Methods Six categories of pts enrolled into this cross-sectional study; AA amyloidosis (AA-a), AL amyloidosis (AL-a), Familial Mediterranean Fever (FMF) pts without amyloidosis, cirrhotic chronic liver disease, non-cirrhotic chronic hepatitis B infection (CHB) and healthy controls (HC). LS assessment by fibroscan were categorized as normal for kPa&lt;7, significant stiffness for kPa≥7, advanced stiffness for kPa≥9.5 and kPa≥F4 stiffness. FIB-4 and APRI scores were calculated for each patient when they indicated chronic liver disease. Pts with known chronic liver disease and viral hepatitis excluded from amyloidosis and FMF groups. Results A total of 165 pts (AA-a, n=65; AL-a, n=15; FMF, n=20; cirrhotic pts, n=16; CHB, n=22; HC, n=27) constituted the study group. Average age was higher in the AL-a group compared to others. Median LS was highest in cirrhotic pts, and it was also higher in AA-a and AL-a pts compared to FMF and HC. Median LS was numerically higher in AL-a compared to AA-a, but it did not reach statistical significance. Median LS was also higher in FMF pts compared to HC. FIB-4 and APRI scores were lower compared to cirrhotic patients in AA-a and AL-a. ALP levels were higher in AA-a and AL-a groups compared to FMF, CHB and HC. FIB-4 and APRI scores, ALP and GGT levels were correlated with LS both in AA-a (r=0.534***,r=0.485***,r=0.437***, r=0.506***) and, AL-a (r=0.536*, 0.579*, r=0.645*, r=0.752**) and FMF-AA (r=0.584***, r=0.566***,r=0.322*, r=0.306*; *p&lt;0.001, **p&lt;0.01, *p&lt;0.5) groups. Higher patient age, age at diagnosis of amylodosis, FIB-4 and LS scores, ALP levels, non-FMF causes of AA were associated with hepatic AA amyloid involvement in biopsy-proven pts. A cut-off value 12.05 kPa of LS provided 100% sensitivity and 85.5% specificity (LR=6.9, AUC=0.901, 95% CI 0.81-0.99) for pts with AA-a. Conclusion In our single center cohort, we showed a higher median LS by fibroscan in both AL-a and AA-a pts compared to CHB, FMF and HC. It was thought to be that fibroscan may be useful in detecting hepatic amyloid involvement. Table 1. AA-a (n=65 ) FMF (n=20 ) AL-a (n=15 ) Cirrhosis (n=16 ) Chronic Hepatitis B (non-cirrhotic) (n=22 ) HC (n=27 ) p 1 p 2 p 3 p 4 p 5 p 6 Age (years)* 46 (19) 42.5(13) 58 (16) 49 (15) 45 (21) 45 (23) 0.4 0.3 0.8 0.5 0.8 0.002 Gender (n, % ) Male 38 (59) 10 (50) 6 (40) 10 (62.5) 13 (59) 17 (55) 0.5 0.8 1 0.7 0.7 0.2 Female 27 (41.5) 10 (50) 9 (60) 6 (37.5) 9 (40.9) 14 (45.2) Diabetes Mellitus (n, % ) 5 (8) 2 (11) 2 (13) 3 (15) 2 (13) 3 (10) 0.7 0.6 0.4 0.8 0.9 0.6 Body Mass Index (kg/m 2 ) * 25.7 (1.4) 25.6 (5.4) 24.8 (3.6) 26.7 (6.7) 25.5 (7) 26 (5.7) 0.9 0.4 1 0.7 0.7 0.3 Liver stiffness (kPa)* 6.7 (5.6) 6.45 (2.7) 9.8 (12) 26.7 (22) 5.7 (5) 4.9 (1.6) &lt;0.001 &lt;0.001 0.03 &lt;0.001 &lt;0.001 0.16 Significant stiffness (kPa≥7 ) 31 (48) 11 (55) 8 (58) 16 (100) 4 (18) 2 (6.5) 0.4 &lt;0.001 0.012 &lt;0.001 &lt;0.001 0.6 Advanced stiffness (kPa≥9.5 ) 17 (26) 4 (20) 7 (50) 16 (100) 3 (14) 0 0.4 &lt;0.001 0.2 0.001 0.02 0.1 S4 stiffness (kPa≥12.5 ) 10 (15) 0 5 (36) 16 (100) 2 (9) 0 0.057 &lt;0.001 0.4 0.02 0.1 FIB-4 score 0.97 (0.9) 0.76 (0.56) 1.3 (0.95) 2.5 (3.4) 0.85 (0.8) 0.7 (0.5) &lt;0.001 &lt;0.001 0.4 0.005 0.6 0.1 APRI score* 0.25 (0.2) 0.26 (0.2) 0.24 (0.2) 0.77 (1.3) 0.22 (0.2) 0.16 (0.08) &lt;0.001 &lt;0.001 0.3 0.002 0.02 0.4 ALP (U/L)* 97 (65) 79 (55) 103 (54) 79 (126) 76 (39) 67 (22) &lt;0.001 0.5 0.002 &lt;0.001 0.002 0.7 GGT (U/L)* 18 (18) 17 (26) 24 (61) 24 (51) 16 (14) 14 (14) 0.07 0.2 0.2 0.07 0.2 0.08 p 1 : AA-a and FMF p 2 : AA-a and cirrhosis p 3 : AA-a and chronic liver disease p 4 : AA-a and HC p 5 : FMF and HC p 6 : AA-a and AL-a *Median, interquartile of range Disclosure of Interests None declared